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Paediatrics > Neonatal > Flashcards

Neonatal Flashcards

1
Q

Gastroschisis Description

A

defect in anterior abdo wall lateral to umbilicus

herniated intestine /w no covering/sac

no associated abnormalities

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2
Q

omphalocele

A

incomplete closure of ant abdo wall

herniated bowel, stomach, liver, spleen in peritoneal sac

often other abnormalities

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3
Q

NRP algorithim

A

dry, stimulate, clear secretions (30secs)

if apnea, gasping or HR < 100: PPV, SpO2 monitor, +/- ECG

HR < 100? Check chest movement, correct PPV. ETT or LMA if needed.

then if HR <60, ETT. Compressions. 100% O2. ECG monitor.

HR still <60, IV epi

HR persistently <60, consider hypovolemia or pneumothorax

if labored breathing or persistent cyanosis only: position + clear airway, supplemental O2 PRN. Consider CPAP.

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4
Q

Preductal SpO2 targets in newborn resusc

A 
1min - 60-65%
2min - 65-70%
3 min - 70-75%
4 min - 75-80%
5 min - 80 - 85%
10 min - 85-95%
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5
Q

changes at birth in circulation

A

hypoxia –> breath

breathing/O2 –> lower pulm resistance, increased pulm blood flow

loss of placental circulation –> increased systemic vascular resistance, closing FO + DA

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6
Q

prematurity acute + chronic morbidity

A

acute:

  • CNS: asphyxia, IVH, seizures, periventricular leukomalacia
  • Resp: RDS, apnea of prematurity (monitoring until 5-8d without apnea)
  • CVS: PDA
  • GI: feeding intolerance, NEC
  • ID: sepsis
  • Derm: temp instability

chronic:

  • HEENT: ROP, hearing impairment
  • Resp: CLD
  • CNS: behavioural, LDs, CP, cognitive, seizures
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7
Q

management of late preterm infants (34+)

A

<35 need NICU, otherwise may not

observe - temp, jaundice, BG, car seat test

careful monitor feeding, weight gain until consistent

risk of readmission

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8
Q

kernicterus diagnosis

A

only dx on histology (see in basal ganglia)

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9
Q

acute bilirubin encephalopathy diagnosis

A

= clinical diagnosis

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10
Q

physiologic causes of jaundice

A

breast feeding jaundice (=not getting enough)

breast milk jaundice (getting enough but reacting to a component)

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11
Q

Pathologic causes of Jaundice

A

Unconjugated/indirect

  • hemolytic: ABO incompatible, fragmentation, spherocytosis/elliptocytosis, G6PD def, PKD, alpha thalassemia
  • others: cephalohematoma, bruising, craig najar syndrome, gilberts, sepsis, hypothyroidism

Conjugated/direct

  • biliary atresia
  • choledocal cysts
  • infections: sepsis, viral, TORCH, UTI
  • metabolic: galactosemia, A1AT def, hypothyroidism
  • long term TPN
  • idiopathic neonatal hepatitis
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12
Q

Jaundice work up

A

universal:

  • TSB before discharge / 72h
  • blood type & screen
  • baby blood type
  • G6PD if ethnic group (consider)

If severe/treating:

  • DAT (coombs)
  • CBC + diff
  • smear & retics
  • unconj + conj serum bili
  • G6PD - if asian or severe
  • consider septic w/u (eg if WBC off, etc)

Note: also do DAT if high-intermed risk and mom is group O

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13
Q

Jaundice likely pathologic if

A
  • jaundice at <24hr
  • bili rises rapidly or very high
  • persists beyond 2 weeks
  • conjugated hyperbilirubinemia (does not cause kernicterus or respond to phototherapy – but must workup!)
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14
Q

treatment for hyperbilirubinemia

A
  • phototherapy (blanket, light)

- if severe, IVIG, partial exchange transfusion

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15
Q

how to dx hyperbilirubinemia

A
  • use nomogram of total bili to decide if phototherapy
  • if no tx, then use 2nd nomogram to determine risk zone + follow-up needed
  • RFs = iso immune hemolytic dx, G6PD, asphyxia, resp distress, lethargy, temp instability, sepsis, acidosis

lines: 38+well, 35-38 + wll or term /w RFs, 35-38 with RFs

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16
Q

signs of kernicterus

A

hypertonia, arcing, retrocolis, fever, opthisthotonos, high pitched cry

17
Q

tx of kernicterus

A

exchange transfusion

18
Q

risk factors for neonatal sepsis

A 
ROM > 18hr
intrapartum fever
maternal GBS
prev infant with GBS
chorioamnionitis
prematurity
perinatal asphyxia
19
Q

micro-organisms for neonatal sepsis

A 
GBS
E coli
Strep Viridans
Strep pneumo
enterobacter
S aureus
H flu
HSV
enteroviruses
20
Q

presentation of neonatal sepsis

A 
non-specific/subtle
poor feeding
lethargy
vomiting
resp distress/grunting/apnea
temp instability
low tone
tachycardia
fever or hypothermia
seizures
petechiae
21
Q

full septic workup

A 
CBC
blood cultures
urinalysis + culture
LP - CSF anlalysis, culture, viral PCR
\+/- CXR, stool testing
22
Q

when to do a workup for sepsis

A

unwell - full w/u

well and multiple RF or chorio: do CBC after 4 hrs

one RF: observe for 24hr, +/- CBC

23
Q

empiric antibiotics for neonatal sepsis

A

ampicillin + gent or cefotaxime

add vanco if >30d, if ?meningitis, or if lines in

add acyclovir if ?HSV

24
Q

Ddx for neonatal resp distreass

A

most common:

  • transient tachypnea of newborn
  • respiratory distress syndrome
  • meconium aspiration syndrome

less common:

  • infection (pneumonia, sepsis)
  • persistent pulmonary HTN
  • pneumothorax, effusion, lung hemorrhage
25
Q

investigation for neonatal resp distress

A

CBC, lytes, BG, blood gas, blood cultures

LP if ?sepsis, meningitis

CXR

echo (esp if severe hypoxemia or ?PPHN)

ECG

pre and post ductal sats (PPHN)

26
Q

Transient tachypnea of Newborn description, dx, treatment

A

“wet lungs”

RF: CS, macrosomia, maternal DM

CXR: parenchymal infiltrates, wet silhouette, intralobal fluid

tx: give O2 PRN

27
Q

Respiratory Distress Syndrome

A

not enough surfactant

RF: male, maternal DM, preterm

tachypnea, hypoxia, cyanosis

CXR: homogenous infiltrates, air bronchograms, small volumes

tx: resusc, O2, ventilate, give surfactant

28
Q

mec aspiration syndrome

A

post-term, SGA

patchy atelectatsis, consolidation

resusc, O2, ventilate, surfactant if severe, abx until cultures back (b/c looks like pneumonia)

29
Q

neonatal hypoglycemia cut off

A

<2.6

30
Q

neonatal hypoglycemia causes

A

endocrine: persistent hyperinsulinemic hypoglycemia of infancy, diabetic mom, LGA, other rare things

perinatal stress
sepsis
RDS
prematurity
PPHN
rare inborn errors of metabolism
31
Q

work-up for persistent hypoglycemia / requiring lots of glucose

A

“critical labs”

  • PG
  • blood gas
  • insulin level
  • GH
  • cortisol
  • FFA
  • beta-hydroxybutarate
  • acyclcarnitinse
  • total and free carnitine
  • serum amino acids
  • ammonia
  • lactate
  • c-peptide
  • urine: ketones, glucose, organic acids, reducing substrates
32
Q

management of neonatal hypoglycemia

A

LGA + IDM: monitor from 2h life to 12hrs. SGA + premies until 36hrs.

monitor PG q3-4h before feeds, then before every 2nd or 3rd feed after 48h

PG < 1.8 at 2h of life despite one feed or <2.0 after any feed: IV dextrose

2.0-2.6 (or 1.8-2 in first 2h): feed. If repeatedly <2.6, IV dextrose

<2.6 and unwell: IV dextrose

33
Q

IV fluid choice for neonatal hypoglycemia

A

start with D10, can go up to D12

34
Q

developmental dysplasia of the hip risk factors

A

breech, family hx, female

35
Q

hip dysplasia mangement

A

positive exam <2wks - ortho referral

equivocal exam 2wks+: US or ortho referral

tx = pavlik harness (abduction brace)

36
Q

Apgar score

A

2 for each category:

appearance / color
pulse (absent, <100, >100)
grimace (floppy, weak, vigorous)
activity (active, flexed, absent)
resp (absent, slow, vigorous)

Paediatrics (23 decks)

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